Most classes of antidepressant medications, including the selective serotonin reuptake inhibitors (SSRIs), are thought to require 2 or more weeks of use before therapeutic effects become noticeable. The consumer guidelines for a drug like Celexa (citalopram) clearly advise patients not to expect immediate benefits but to continue taking their medication as prescribed. However, a recent study has cast doubt on the notion that SSRIs really take weeks to build up to therapeutic levels. If the results are confirmed with subsequent experiments, then our understanding of these medications will be greatly enhanced. Observing the neurochemical mechanism behind specific SSRIs will naturally lead to more beneficial prescribing patterns and better patient outcomes.

In a study of the SSRI Celexa, 26 participants were given either a single dose of the drug or a dose of placebo, a harmless sugar pill. None of the participants had depression, a fact which allowed researchers to study specific physiologic responses without interference. Three hours later, participants were shown images of frightened faces while brain activity in their amygdala was measured via magnetic resonance imaging. Psychiatrists have theorized that hyperactivity in the amygdala is a measurable effect of depression that places the individual in a constant state of heightened anxiety. In the single-dose Celexa study, participants given medication showed a muted response in their amygdala when viewing frightened or anxious faces. Researchers observed a spike in amygdala activity in those who received placebo. These findings demonstrate that potentially therapeutic effects begin as quickly as a few hours after the first dose of Celexa, and by extension any SSRI. Interestingly, none of the participants reported either a change in mood or unusual side effects. The study authors theorize that the action on the amygdala has both immediate benefits on an unconscious level and longer term effects on anxiety.

Depression is often described as a constellation of symptoms and effects. Because of its many manifestations, the disease is a long way from being fully understood. There is currently no fool-proof, one-size-fits-all treatment for depression. Research on antidepressant medications like Celexa helps us identify what’s happening in the depressed brain. Armed with that knowledge, we can tailor more effective medications in the future. The study under discussion, for example, highlights the possibility that Celexa’s beneficial effects begin with the amygdala, the brain’s primitive fear center. More importantly, these effects begin almost immediately, contrary to previous assumptions.

References
Murphy, S., Norbury, R., O’Sullivan, U., Cowen, P., Harmer, C. (2009). Effect of a single dose of citalopram on amygdala response to emotional faces. British Journal of Psychiatry, 194(6), 535-540.

Most parents don’t need an expert or a study to tell them what they already know: kids get more homework now than they ever have before, with many high schoolers getting as many as seven or eight hours of homework a night. Most parents are as overwhelmed by homework as their children are and constantly struggle to create incentives for their children to complete their piles of homework. Many parents believe they’re fighting this homework battle to ensure a quality education for their children, but the truth is that there’s little evidence that excessive homework helps children learn. Indeed, evidence is rapidly amassing that overworking children interferes with their ability to learn.

Understanding Learning

Our brains are programmed to learn things that are interesting to us and relevant to our lives. You’re more likely, for example, to remember where the aggressive dog who always chases children lives than you are to remember the color pattern on your neighbor’s shirt. Children in particular are primed to learn things that help them better function in their environment. Unfortunately, homework doesn’t pass this test. The overwhelming majority of homework assignments force children to sit down and memorize facts rather than experience their world. Not only does this make information more difficult to learn; it can also decrease your child’s motivation to learn. When learning is made miserable, children associate the thing they’re learning with misery and want to avoid it. This is why tactics such as forced silent reading time or flashcards rarely help children learn math and vocabulary.

The Stressed Brain

Even when homework is well-designed and does foster learning, too much of it can be damaging. Children who have more than one hour of homework each night overwhelmingly report that they feel stressed about their ability to complete their work. Over time, this stress can create real problems for a developing brain. When we are under stress, the brain produces cortisol, which lowers immune function and processing speed. On a short-term basis, cortisol can help us deal with stress. But when the brain is constantly releasing cortisol, development and learning can slow. This is especially damaging for children, whose brains are rapidly laying down neural connections. Even more troubling, excessive doses of cortisol can damage the hippocampus, which plays an important role in memory, inhibition, and spatial reasoning.

Fewer Activities

The value of friendships, extracurricular activities, and relaxation time to children’s intellectual and emotional development has been extensively documented. When homework is overwhelming, however, children are less likely to have the opportunity to participate in these activities. Thus even a child who is left unfazed by excessive homework or who excels in school may suffer as a result of excessive homework because he’s unable to engage in the activities that can help him become a well-rounded adult.

A Better Approach to Homework

Homework can help bridge the gap between home and school, encourage independent learning, and give children who find school stressful an opportunity to learn at home. So what are the characteristics of “good” homework assignments? They include:

• Activities that encourage students to interact with their environment
• Activities that give students flexibility to focus on things they are interested in
• Activities that make learning relevant instead of flashcards and drills
• Reasonable amounts of time spent on homework—no more than one hour for young children and no more than two hours for high schoolers
• Activities that can be completed at home without substantial cost or the purchase of lots of supplies

When choosing a school or classroom for your child, ask about homework and advocate on your child’s behalf when homework becomes excessive. Your child’s stressed mind will thank you, and your child just may end up learning more.

References:

1. Gerhardt, S. (2004). Why love matters: How affection shapes a baby’s brain. New York, NY: Brunner-Routledge.
2. Harwood, R., Miller, S. A., Vasta, R. (2008). Child psychology: Development in a changing society. Hoboken, NJ: John Wiley & Sons.
3. Hirsh-Pasek, K., Golinkoff, R. M., Eyer, D. E. (2004). Einstein never used flash cards: How our children really learn–and why they need to play more and memorize less. Emmaus, PA: Rodale.

If you are reading this article, then you probably have completed Codependency Workbook Exercise Two by creating a list of your troubled relationships. Congratulations for completing this. Generally, in codependent relationships there is some pain and emotional abuse. They tend to be rather lopsided, with you doing most if not all of the giving. When you realize this, you may get angry and feel as though others are using you. You may wonder why this is. It is because when they meet you, they sense that you are a caretaker who will want to help them. When you do this, it is because you care about them and believe that you can love and care some of their problems away. Most of the time this cannot be done. Often, by giving to them, you are actually making it easier for them to continue their maladaptive behavior.

If your loved one gets a DWI, you may rush out and hire a good lawyer who may get him or her off. Had this person suffered the consequences of the DWI, he or she might have been ordered to complete substance abuse treatment, which might have ended or at least interfered with the drinking. So if you are in a relationship with a person with an alcohol or drug problem, can you think of a boundary that you could set that would be good for you and, in the long run, him or her? For example, you might tell this person that if he or she has another legal problem related to substances, that you will no longer help. The person will be on his own. Of course, he or she may not like this and try to push your guilt buttons. Remind yourself that you are not only doing what is best for yourself but also for the other person. You might take your boundary a step further and tell the person that effective immediately, you will no longer undo any of the consequences of his or her using. I suggest you only set the boundary when you are ready. The hard part will come when you have to stick to the boundary. You will need some support from a therapist, your sponsor, or a friend to hold to it. Once you maintain a boundary you will find that it is easier to stick to the next one.

What are some other boundaries that you might set? Maybe you have a friend who borrows money from you and has never paid it back. The next time the friend asks to borrow money, you might tell him or her that you are unwilling to loan any more money until the person repays you the funds already owed. Maybe you have someone who always asks you for rides but never offers to pay for your gasoline. You might decide to tell this person that you cannot afford to continue giving him or her rides. Make a list of all the boundaries that you need to set to take care of yourself. While you are identifying them, do not worry about actually setting them. Try to take one step at a time. I know that the thought of setting them is very scary. You may also be scared about what will happen to your friend if you set them. If your friend is dysfunctional, something will happen to this person no matter what you do. Once you get the hang of doing this, you are going to feel an enormous sense of relief. You will realize you are not responsible for everybody, nor do you have to help someone just because that person needs it.

If you are like some people, you may fear that if you stand up for yourself, you will be abandoned by your friend. I believe that if this happens, then that person was not really a friend to begin with. Can you imagine treating someone that you care about like that? I am sure that you cannot. Now you will have more energy to direct toward taking care of yourself. You will no longer feel so angry at others. The next time you feel like a victim, you may need to check and see if you need to set another boundary.

Dosage guidelines for new pharmaceutical products are typically based on strictly controlled clinical trials that may not represent every possible patient or situation. In practice, physicians often find that dosages must be raised or lowered to achieve ideal efficacy. Geodon (ziprasidone), an atypical antipsychotic, is one such example of a psychotropic medication for which recommended dosing and real-world practice do not always agree. The use of Geodon with schizophrenia patients is well documented, and dose levels are equally well understood. With bipolar disorder, however, the picture is not as clear. Best practices for prescribing Geodon to individuals with bipolar are still being determined.

Several studies have proven that Geodon brings about significant and remarkable rapid improvement in manic or psychotic symptoms of bipolar. The current clinical guidelines suggest beginning with a daily dose of 80 mg, then stepping up to a dose ranging from 120 to 160 mg. There is compelling evidence, however, that initializing treatment with a high dose of Geodon, rather than the “step up” approach, leads to better outcomes and a greater likelihood that the individual will stay the course. As with many psychiatric disorders, patients with bipolar often neglect to stick with their medications. When symptoms can be improved more rapidly, patients have immediate motivation to follow their prescriptions more strictly.

A study in Korea assessed the response of individuals with bipolar to varying dosages of Geodon over a 6-week period. Some individuals were started at a low dose and then stepped up, while others began treatment at the higher dosage. The results demonstrated that patients who began with the higher dosage had better remission of bipolar manic symptoms and scored better at the end of treatment on a variety of psychological wellness tests. Furthermore, there was no significant difference between the groups in terms of side effects or withdrawal from the study. These results strongly suggest that there is no benefit to beginning treatment at a lower dose, despite recommendations from the drug maker.

Geodon belongs to the class of atypical antipsychotics, but its activity on the neurochemical level is unique among its peers. Because of its unique properties, Geodon is effective in the treatment of a variety of mental illnesses, and it is considered relatively safe and well tolerated. The drug’s usefulness in treating bipolar is still somewhat unknown. Research in Korea and elsewhere, however, has shown that starting individuals with bipolar who are experiencing manic symptoms on a relatively high dose of Geodon is a feasible first-line treatment.

References

1. Woo, Y. S., Bahk, W., Jo, S. H., Yoon, B., Lee, J. G., Kim, W., et al. (2011). Effect of initial ziprasidone dose on treatment outcome of Korean patients with acute manic or mixed episodes. Psychiatry Investigation, 8, 207-213.
2. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Ziprasidone. Retrieved March 10, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001070/

With the advent of easy plane travel, many larger businesses have grown to include regional, national, and even international customers and work sites. People who work at the higher levels of industries often find their jobs are not done just at their desks, no matter how well connected they are electronically. Business relationships, decisions, and inspections can’t all be done without physically being on-site, and long-distance and extended travel are part of the job.

You may look upon that lifestyle with envy. Well, don’t. Having worked with dozens of families and couples who have held jobs like this, I can tell you, from their experience, that these jobs can take a very heavy toll on satisfying family relationships. Before you make that big job your goal, I hope you’ll first consider what it can demand from your life.

1. Physical toll: Traveling is exhausting no matter what class of seat you have on a plane. When you travel, your body is in a constant state of adjustment to different food, water, accommodations, climate, work expectations, and time zones. Any kind of steady, healthy patterns of sleep, exercise, nutrition, and relationships are interrupted, and it’s rough to try to keep up with good health habits somewhere else.
2. Exit/reentry transitions: Life keeps moving on in your home, despite the traveler’s schedule. When you’re trying to pack, with your mind on the journey ahead, the family may feel your absence even while you are still home. Arriving home can be worse, as you’d love to be welcomed home with excitement, while the one who has been at home may want nothing more than to be relieved of the additional responsibilities he or she has been shouldering.
3. Parenting patterns: When one parent in a family travels for work, the remaining parent has to temporarily become a single parent. Leadership around finances, yard work, car repairs, play dates, and school assignments have to shift to the parent who is home. Children can get accustomed to the traveling parent being the “fun” one who comes home with gifts and days off, leaving the at-home parent as the disciplinarian and enforcer, who becomes used to making parenting decisions solo.
4. Emotional isolation: After spending enough days of the month away from home, it becomes very easy to live two lives: one on the road and the other at home. Even with regular phone, text, email, and Skype connections to those at home, the relationships that develop with those who share the travel with you can become more real to you than the ones you leave behind. Isolation, prestige, repetition, or intensity of the shared work adds to that other-worldliness. It’s at this level of isolation that I have seen long-term affairs, addictions, mood disorders, and health issues surface. These issues are not easily or often repaired.

Human relationships need physical proximity, regular conversation, shared patterns of caregiving, humor, health, and equality to thrive. Trying to have all these while traveling for a job is like trying to juggle three balls when all you’ve ever managed were two. If you are struggling with any or all of these issues as a family or couple, I encourage you to reach out to a family therapist in your area, who can help you manage the human challenges of traveling this much. While it’s not impossible to thrive, it is tough. Best buckle up. The captain has turned on the fasten seat belt sign.

All too often, compromised energy levels are a lingering impact of traumatic experiences, particularly ongoing or frequent traumatic events in childhood.

Compromised energy means that you simply do not have enough energy to tackle certain tasks. In addition, traumatic experiences often prevent people from learning how to manage their energy levels. This encompasses everything from recognizing when you are running low on energy to knowing how to build an energy reservoir and stamina.

Understanding Energy

Take a quick moment and think about all the energy it took to get through today. Think about the physical energy, as well as emotional and mental energy. Of these three types of energy, physical energy is possibly the most obvious. We have all experienced times when we were simply too tired to engage in a task because our physical energy was just not up to it. Many factors, including sleep, nutrition, exercise, medications, and substance use, can impact your physical energy level.

These factors also impact your emotional and mental energy levels. Emotional energy is used when you interact with emotions, whether in a productive or unhealthy manner. You use emotional energy when you identify an emotion, express it, act on it, calm it, understand it, and so on. Mental energy is the energy you use when thinking, planning, making logical decisions, and following through with your decisions and plans.

When traumatic life events have “stunted” your development of energy management tools, it is important to include learning these skills in your healing work. Broadly speaking, there are three categories of skills you will want to learn for each of the types of energy: the skills necessary for monitoring your energy level, those needed in order to manage your energy, and those that will increase the staying power of your energy.

Monitoring Your Energy Levels

How aware are you of your physical, emotional, and mental energies? Is there one type of energy that you are more aware of? Do you recognize when these energy levels are full and geared up for action, when they are at their midpoint, or when you are close to being empty? Or do you only become aware of your energy level when you are past empty and burnt out? Becoming aware of energy levels before you hit burnout will allow you to refuel before you run out of energy.

Physical energy can be a great one to start practicing these skills with. Take some time throughout the day—maybe every hour or two—and check in with yourself. How awake or tired are you? How full or hungry?

Imagine your energy levels as a gas gauge with marks at full, ¾ full, ½ full, ¼ full, and empty. When you check in with each of these physical experiences, determine where you fit on that scale.  Are you past the point of energy, but not quite tired? Are you not full but not hungry? By figuring out where you’re at, you can determine what you need to do to manage your energy and satiation levels: take a nap, go on a walk, eat a snack, say no to the offer of a snack, or whatever works for you.

Managing Your Energy

Once you can identify your energy levels, you can determine what you need to do to keep your energy at workable and beneficial levels. Let’s look at emotional energy. Say your emotional energy is still at the ¾ full mark, despite it being late in the day. Maybe now would be a good time to call a friend and extend support. Maybe you can take time to reflect on, process, or journal about a recent upsetting experience.

If you notice that your emotional energy is close to empty, but you still have a few emotionally taxing tasks to do,  it would be wise to carve out a bit of time to refuel yourself. Reach out to an emotionally supportive friend, take a break and head to an emotionally restorative place in nature (even if it is just smelling the neighbor’s roses), or take a few moments to breathe deeply, read an encouraging piece of prose or poetry, and so on. If you become aware that you have experienced several days on empty, you may want to consider dedicating your weekend to replenishing, rather than extending, your emotional energy.

Building Energy Reserves and Stamina

If learning how to replenish your energy reserves is one side of a coin, then building stamina is the other. This skill requires a great deal of gentleness and care: many survivors of trauma push themselves to have too much stamina, not allowing themselves to honor their limits.

With this in mind, building your stamina is nonetheless an important pursuit. Just like building physical stamina, developing a deeper mental energy reservoir requires practice in small increments. When you notice that you are approaching empty, but not quite there yet—somewhere just less than ¼ full—gather your mental energy and sustain your focus and effort for another 10 to 15 minutes. Rather than exiting the activity to replenish your energy level, stay engaged and practice hanging in there. If you simply do not have enough mental energy to stay with your current task, try switching to a less demanding activity that still engages your mental energy.

Use Energy to Bring Healing to Your Life

Feel free to play with these ideas and apply the ones that resonate with you. Practice each type of skill (monitoring, replenishing, and building stamina) with each type of energy (physical, emotional, and mental). Be as creative as you can be and brainstorm additional ways to grow these skills. In so doing, you reclaim crucial abilities and further your healing.

Practice these skills in a safe environment and in a manner that can only benefit you. Never do anything in the name of healing that could actually bring damage to you. As always, keep in mind that you do not need to heal on your own. Reach out to support groups, loving friends, supportive family, and trained professionals. We are all here to help you grow.

Children with social, emotional, and behavioral difficulties (SEBD) often exhibit speech, language, and communication needs (SLCN) as well. Clinicians and educators who work with these children have the challenge of identifying which type of treatments will best serve the needs of these special children. SEBD has been shown to be linked to communication deficits, but this relationship has not been fully explored. Gender, social conditions, intelligence, and relationship styles are factors that contribute to both SLCN and SEBD. Most children with these problems are not identified until they enter school, making the correlation between them more convoluted. For instance, executive function deficits may not be discovered until children enter school and exhibit symptoms of attention deficit hyperactivity disorder (ADHD). Other children may live with negative psychological and physical conditions such as abuse or neglect that can cause the children to stifle their communication, resulting in communication problems later on.

The most common type of treatment for SEBD is cognitive behavioral therapy (CBT). In a recent analysis of existing research, James Law of the Institute of Health and Society at Newcastle University in the UK looked to see whether CBT was ever combined with communication therapy for children. He also studied the research on CBT outcomes in children with Asperger’s, autism, and anxiety to determine whether the therapy had any positive impact on communication skills. For his research, Law examined 19 separate studies that included data from 148 children with SEBD and SLCN.

Although Law did not isolate one particular CBT approach that would be most beneficial for these children, he did discover that variation in communication enhancement techniques had a positive impact. Specifically, more formal techniques appeared to help the children with autism spectrum issues the most, and naturalistic and educational approaches were identified as effective methods for children with mild communication and behavior problems. In conclusion, Law added, “The potential overlap between SLCN and SEBD needs to be widely recognized by practitioners, and the implications for practice of this overlap explored more fully.”

Reference:
Law, J., Plunkett, C. C., Stringer, H. (2012). Communication interventions and their impact on behaviour in the young child: A systematic review. Child Language Teaching and Therapy, 28.1, 7-23.

The process of trauma recovery includes developing a narrative to one’s history, compartmentalizing who is accountable for what, and integrating old material into a new paradigm. Intrafamilial abuse, particularly child abuse, is often layered and complex. The locus of the early stages of the work tends to be the perpetrator of physical, sexual, or emotional injury. However, throughout the progression those who failed to protect slowly come into focus.

Survivors express uncertainty around the parent who did not harm them but did not protect them either. As therapists, our energy is directed towards ensuring that the burden of abuse lies in the hands of the perpetrator. Clarity and relief are common responses to unraveling culpability.

The circumstances under which there is a nonoffending parent (or community) who also failed to protect a child can complicate recovery. Clients report strong feelings towards those who did not keep them safe and express confusion about who or what this person is. “Are they an abuser? Did they love me? If they did how could they have allowed this to happen? How can you watch your own child being abused and not intervene? Is there something wrong with me?”

Abuse in its various forms can sometimes be less convoluted than the failure to act, respond, or protect. It is a complex endeavor to absorb exactly how one can avoid acting in response to someone harming a child. Professionals such as teachers, therapists, or anyone who has regular contact with children are required to report suspected abuse.

In some states, law enforcement is required to intervene on some level with domestic violence, while child protective services views domestic violence as a threat to the well-being of the children in the home. Implicit in such requirements is that there is some culpability in failing to protect. Yet defining nonoffending parents can be arduous for both clients and therapists.

Perhaps our task as helping professionals is to develop our own understanding of parents who, for whatever reason, do not or cannot protect their own children. I often find myself aligned with my clients’ confusion. While not always completely clear or simple to define, categorizing abusive acts as wrong seems more clear than failure to protect, and even more so if the person who did not intervene was a parent.

There appears to be some collective agreement that those outside of the family have a responsibility in safeguarding those who cannot defend themselves. It feels a bit more muddled in applying these rules to family members. How do we define a parent who is otherwise loving and warm but has knowledge of the abuse and does not intervene? Even if the parent is disengaged or emotionally absent, how do we work with our clients in defining them? Is a failure to act a form of abuse in itself, or is the nonoffending parent a victim as well?

The ethics of community response to failure to protect remains convoluted. In addition, working with our clients in understanding this aspect of their story is a delicate pursuit. The circumstances of the client’s story can occasionally provide the answers to our questions. Most of the time, context fosters few explanations. Perhaps in this case, the conclusion lies within the question — bemusement exists because this is a complex issue.

Normalizing a lack of clarity and difficulty in compartmentalizing the nonoffending parent or family member is difficult for all of us, not only the survivor. Hopefully, acknowledgment of the layers and intricacies of intrafamilial abuse is a starting point for all of us, and at least survivors have a partner in their journey for answers.

Several research studies have investigated the possibility that the antidepressant medication Luvox (fluvoxamine) could be an effective therapy for alcoholism. Most of the studies involved rats, but researchers consider the results applicable to humans as well. Despite the enormous public health burden of alcoholism, treatments for the disease are still well behind the curve. The rate of successful remission and abstinence is low, regardless of treatment plan. Comorbid disorders such as severe depression or anxiety further complicate matters and increase the likelihood of eventual relapse. Adequate treatment usually requires a combination of approaches—cognitive therapy for treatment of mood disorders, pharmaceuticals for managing alcohol withdrawal and cravings, and ongoing counseling to reduce the chances of a return to drinking.

A study with lab rats revealed that Luvox potentially reduces the response to food, or alcohol, or both, depending upon the experimental conditions. The goal of the study was to determine if Luvox might reduce the craving for alcohol, but the results were not conclusive in that regard. Significant changes in stimulus response were recorded even at very low doses of the medication. When food and alcohol were presented together, rats treated with Luvox responded less to food but maintained the same consumption of alcohol. However, presenting one stimulus and then another in sequence had differential effects. Responses to the second stimulus, regardless of whether it was food or alcohol, were decreased in the presence of Luvox. The temptation has always been to link all reward-seeking behaviors into a single category. Studies like the above, however, demonstrate that food-seeking and drug- or alcohol-seeking are biologically distinct events. The intricate and complex workings of such behaviors are still largely mysterious.

Due to uncertainties in its effectiveness for the purpose, Luvox is unlikely to play a role in the reduction of alcohol cravings. The rat studies returned mixed or confusing results, and no human trials have demonstrated a predictable, reliable mechanism of action. At this time,  there  isn’t enough evidence to conclude that the medication can successfully manage alcohol cravings. However, Luvox is effective in treating the depression and anxiety that accompany the recovery process after alcoholism. As a safe and effective mood stabilizer, Luvox reduces the chances of relapse. When Luvox is combined with cognitive therapy, a person recovering from alcohol addiction has a high likelihood of achieving a healthy outcome.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ginsburg, B. C., Lamb, R. J. (2006). Fluvoxamine effects on concurrent ethanol- and food-maintained behaviors. Experimental and Clinical Psychopharmacology, 14(4), 483-492.

We all experience losses, big and little, throughout our lives. When enduring a big loss, people fall into patterns that may be considered masculine or feminine ways of reacting.

Men and women tend to process their losses differently, but the way they grieve is affected by many other factors besides gender, such as culture, personality, and temperament. Grief and loss are experienced in unique ways by each individual.

A generalization about gender differences in grieving would be that men tend to focus on feelings of guilt and anger. They are likely to spend more time thinking than feeling. They also tend to act independently rather than rely on others.

Women typically need more support and are expressive with their emotions, which is behavior we tend to associate with grief and loss. However, there is no cookie cutter approach to mourning. In recent years, experts like Kenneth Doka, PhD, have recategorized these types as intuitive and instrumental grief.

Intuitive grief can be associated with our generalizations of the way that women grieve, which includes the following:

• Strong, affective reactions (waves of powerful emotions)
• Expressions that mirror feelings (more like an open book)

Moving forward involves exploring and expressing feelings, progressing through the pain in order to heal.

Instrumental grief can be associated with the masculine way of grieving, which includes the following:

• More thinking than feeling (an inward, quiet process, less expression of emotions)
• Being physical, expressing grief through doing something (I could not fix my son, but
  I can fix this broken fence)

So how do you help someone who doesn’t want to talk or ask for help?

• Use logical analysis—figuring out problems by breaking them down into manageable steps (to be less overwhelming)
• Gather information—on new roles (in your household, family, work, etc), supports, faith, to do lists, etc., in order to start implementing
• Use humor—It has much of the same release as crying does, and it’s still okay to laugh
• Provide diversions/distractions—list all supports and assign them to categories
  • Good doers (who could take care of the pet, get the paper, etc.)
  • Good listeners
  • Good respite (who could take a break from the grief and will not ask you about your loss)

Instrumental grievers would benefit more from groups that focus on a how-to (like being a single parent), adventure based, informal or educational, than a traditional support group.

Like any other model for grief, there are several tools you can use with variations for each person. There are always ways to help. You can start by figuring out which support is needed and offer it. And if you need help, ask for what you need. Just know that there is never a wrong way to grieve.

There are a number of different experiences that can cause a child to develop maladaptive coping tendencies. Children who are emotionally or physically abused, neglected, or raised in extremely stressful environments may internalize their emotions. Likewise, children who have experienced sexual abuse may dissociate as a way of defending themselves from the psychological harm that results from sexual abuse. Trauma suffered in childhood increases the risk for dissociative behaviors. Auditory hallucinations are one form of dissociation and are evident in individuals with mental illnesses such as schizophrenia. To better understand how childhood trauma, dissociation, and hallucinations are related, F. Varese of the School of Psychology at Bangor University in the United Kingdom recently led a study comparing the dissociative behaviors, childhood traumas, and cognitive discrimination of 45 individuals with schizophrenia and 20 participants with no prior hallucination history.

Because dissociation is recognized as a pathway for hallucinations and an outcome of childhoodtrauma, Varese sought to determine if the frequency and type of trauma influenced hallucinations and the capacity to determine real and imagined events in the participants. Using a signal detection performance task (SDT), Varese found that the participants with a history of childhood sexual abuse were the most likely to experience dissociative behaviors that resulted in hallucinations. The frequency of abuse was directly related to the level of dissociation, with the most severely abused participants exhibiting the highest levels of hallucinations. The findings also showed that the participants with infrequent hallucinations had lower levels of abuse and dissociation than those who experienced more hallucinations. Varese believes that further research is needed to determine if adult stress and trauma rather than childhood trauma contributed to the intermittent hallucinations in the participants with sporadic dissociative behaviors. In sum, these results suggest that a better comprehension of the type of abuse suffered may be the key to developing effective treatment strategies for individuals who experience hallucinations. Varese added, “Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g., deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.”

Reference:
Varese, F., Barkus, E., Bentall, R. P. (2012). Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychological Medicine, 42.5, 1025-1036.

Cognitive fusion is a process that involves attaching a thought to an experience. Cognitive fusion is beneficial in many ways. Through the process of cognitive fusion, people can become interested in story lines in movies and books because they attach their emotions to the events. Hobbies that elicit positive feelings can be enhanced as a result of cognitive fusion as well. Even feelings of love can be influenced by cognitive fusion. But this process can also impair behavior in individuals with certain psychological issues. People who struggle with anxiety and depression experience negative thoughts that can prevent them from taking positive actions. For instance, when someone with depression focuses on feelings of worthlessness because they have been unable to overcome their depression, they may continue to avoid seeking help because of the perceived outcome. Individuals who suffer with anxiety also find themselves trapped by cognitive fusion when for instance, they believe they will panic if they are exposed to stressful situations, and therefore avoid all situations that could induce stress, even if they are necessary for recovery.

Understanding how cognitive fusion affects mental health is a relatively new area of research. Acceptance and commitment therapy (ACT) is a mindfulness-based therapeutic approach that teaches clients how to accept negative feelings independently of perceived outcome. Therefore, ACT and other mindfulness techniques aim to teach cognitive de-fusion. Because there is little evidence exploring this, Kristen N. Herzberg of the Department of Psychology at the University at Albany of the State University of New York, recently conducted a study that employed a new tool to measure the effectiveness of ACT on cognitive fusion.

Herzberg and her colleagues developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) and administered it to over 900 individuals, half of whom struggle with extreme anxiety, undergoing 12 weeks of internet ACT treatment. She found that BAFT was quite accurate at identifying levels of cognitive fusion. Specifically, the BAFT was able to measure anxiety sensitivity, avoidance, and cognitive de-fusion in the participants. The results also showed that the anxious participants saw significant reductions in avoidant behaviors after completing the cognitive fusion–targeted ACT program. Herzberg added, “Taken together, these findings suggest the BAFT to be a reliable, valid, and useful measure of cognitive fusion.”

Reference:
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment. Advance online publication. doi: 10.1037/a0027782